Abstract 20562: Metabolic Syndrome and Pulmonary Hypertension Due to Left Heart Disease
Heart failure (HF) and metabolic syndrome (MS) are two major healthcare burdens in the United States. A third of the adult population has 3 or more of the risk factors for MS which include obesity, hypertension, diabetes, hyperlipidemia and high HDL cholesterol. Abnormal LV diastolic function is prevalent in 29-35% of those with MS. HF patients with diastolic dysfunction (DD) who develop pulmonary hypertension (PH) have an increased rate of mortality that correlates with increased systolic right ventricular (RV) pressure. Post-capillary PH is most frequently due to elevated left atrial pressure (WHO group II PH) but some patients develop combined pre- and post-capillary PH due to an element of pulmonary vascular remodeling occurring in the setting of longstanding elevated left atrial pressure. We hypothesized that patients with DD and MS are pre-disposed to pulmonary vascular remodeling and the development of pre-capillary PH. DD patients with PH were identified from a right heart catheterization database based on mean pulmonary artery pressure > 25 mmHg and pulmonary capillary wedge pressure > 15 mmHg. Of 39 patients: 12 were classified as pre-metabolic syndrome (Pre-MS: Obesity and hypertension or Obesity and diabetes), 7 had MS (Obesity, hypertension and diabetes), and 21 had only DD. MS patients had significantly increased systolic RV pressure, pulmonary vascular resistance, transpulmonary gradient and pulse pressure compared to DD and Pre-MS patients (P < 0.05) (Figure 1). The incidence of death or transplant (DD: 29%, Pre-MS 55% and MS: 86%) increased with additional risk factors of MS. In conclusion, patients with metabolic syndrome have increased pulmonary vascular remodeling (elevated TPG), increased vascular stiffness (elevated pulse pressure) and increased mortality.
Figure 1. Pulmonary hemodynamics in non-obese (DD), pre-metabolic syndrome (Pre MS) and metabolic syndrome (MS) patients. * P < 0.05.
Author Disclosures: R.R. Vanderpool: None. S. Shterental: None. T.N. Bachman: None. M.T. Gladwin: Consultant/Advisory Board; Modest; Bayer consultant/advisory board, not to exceed $10,000 in calendar year, plus travel (travel total $9,941 for past year). Other; Modest; Co-inventor on U.S. government patent for nitrite salts for the treatment of cardiovascular indications, licensed and held by the NIH. Royalities for past year were approximately $800. Research Grant; Significant; NIH and NHLBI - P01 and R01 grant support to University of Pittsburgh (not to Dr. Gladwin), HCWP and ITXM Institute funding to University of Pittsburgh (not to Dr. Gladwin), Bayer Corporation funding (Ana Mora PI, funds to University of Pittsburgh). M.A. Simon: None.
- © 2014 by American Heart Association, Inc.